Epidemic keratoconjunctivitis

Background

• Form of viral conjunctivitis that causes keratitis in addition to conjunctivitis
• Caused by adenovirus infection that is highly contagious and tends to occur in epidemics
  • Highly contagious and potentially vision-threatening
  • Transmitted via contact with infectious fluids (commonly tear fluid) on hands, tissues, etc

Clinical Features

Subepithelial infiltrates in epidemic keratoconjunctivitis

• Ranges from subclinical conjunctivitis to severe disease with superimposed bacterial infection and systemic symptoms.
• Can be preceded by prodrome of cough, fever, malaise, myalgias, nausea/vomiting
• Worsening foreign body sensation (starts near medial canthus and spreads laterally), followed by:
  • Lid swelling
  • Tearing
  • Itching
  • Photophobia
  • Blurred vision
  • Conjunctival injection
  • Papillae of inf palpebral conjunctiva
  • Ipsilateral pre-auricular lymphadenopathy
• Slit lamp exam - diffuse, superficial keratitis but no corneal ulceration
  • Subepithelial infiltrates likely secondary to adenoviral antigens deposited in corneal stroma
  • These lesions usually regress within 3-6 weeks, but can last for months (and cause vision impairment if within the visual field)

Differential Diagnosis

Conjunctivitis Types

• Viral conjunctivitis
  • Epidemic keratoconjunctivitis
  • Herpes zoster ophthalmicus
  • Herpes simplex keratitis
• Bacterial conjunctivitis
  • Gonorrheal conjunctivitis
  • Chlamydia conjunctivitis
• Allergic conjunctivitis
• Caustic keratoconjunctivitis

Evaluation

• Clinical diagnosis

Management

• Artificial tears
• Cool compresses
• Cycloplegics if photophobia is severe
• Rigorous hand hygiene to prevent transmission

Disposition

• Discharge with rapid ophtho follow-up.

See Also

• Conjunctivitis